A practice that doesn’t file claims to insurers after patient encounters doesn’t get paid, and if you file claims without checking for errors, you still might not get paid. However, claim errors are nearly impossible to avoid unless you turn to claim scrubbers. Although there are people who work as claim scrubbers, you’ll face far fewer denials if you use automated programs instead. Learn all about these programs below.
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Claim scrubbing is the process of scanning your practice’s medical claims for errors that would cause payers (i.e., insurance companies) to deny the claim. Claim scrubbers, whether people or computer programs (we’ll explain both in a bit), verify the Current Procedural Terminology (CPT) codes on your claims. This is important because, although representing your services with five-digit numbers is convenient, just one wrong digit can result in denied claims.
Claim scrubbers are primarily available through third-party medical billing services. For example, the medical software company athenahealth uses automated rule engines to identify mistakes that would lead to denials. Medical billing company AdvancedMD goes a step further and uses its clearinghouse partner’s preferred scrubbing tool. In both cases, the vendors’ claim-scrubbing technology catches errors far better and faster than humans can.
For the above reasons, when you see the term “claim scrubber,” you can generally assume it refers to automated third-party services. Yes, individuals can scrub claims, but you’ll soon learn that there’s little reason for anyone on your medical staff to do it.
“Claim scrubbers” can technically refer to medical billing staff, but it more frequently refers to third-party medical billers’ automated tools.
Claim scrubbing is a process that your front-office staff could theoretically handle manually. After all, they have eyes and brains, so they would be able to see CPT codes and verify that these numbers match the services provided. In reality, though, it’s a formidable challenge to understand and recognize each of the thousands of CPT codes. Plus, to ensure HIPAA compliance, CPT codes are constantly changing.
CPT codes change regularly for HIPAA compliance, so claim scrubbing is vital to ensure accurate claims.
Additionally, even front-office staff members who do know CPT codes might miss incorrect codes. When they’re looking at code after code, they will inevitably start to gloss over the details. This is why you often miss obvious typos when you write, and why your front-office staff might miss incorrect codes. Just as spell-check exists for catching typos, computer tools exist for scrubbing claims.
Claim scrubbers work by checking claims for errors after creation but before filing with payers. Once a claim is created and ready to submit, claim scrubbers scan it for errors before it goes anywhere. If claim scrubbers detect errors (and mistakes are common), a medical biller or coder will manually rectify the claim. Assuming the biller or coder follows the claim scrubber’s exact instructions, claims approval is likely.
You may occasionally encounter something called a “charge scrubber.” This term is roughly the same as “claim scrubber,” though technically, charge scrubbers check for errors before a claim is even created. The result is ultimately the same – accurate claims with quick verification times. It’s just the timing that’s different.
The importance of claim scrubbing can’t be understated. These are some key reasons why claim scrubbers should be part of every practice’s medical billing process:
The obvious benefit of claim scrubbing is that it results in more accurate claims. The more often your claims are accurate, the fewer denials you face. As a result, you’ll encounter fewer obstacles to getting the money you need from payers.
Denied claims hold up the payment process. With no approval on your claims, how can you receive payments? With claim scrubbers, you’re far more likely to submit an accurate claim the first time, enabling payers to pay you on time. The result is more revenue and cash flow that your practice can use to cover its needs.
Manually poring over your claims for errors isn’t just an easy way to make mistakes; it’s also time-consuming. With claim scrubbers, your team spends no time on the process. Instead, a computer program does the work more efficiently and quickly. You’ll catch far more errors in a fraction of the time, and your front-office staff can use that newly freed time for actual patient interactions.
In 2019, 92% of Americans had health insurance. That means payers, not patients, are the primary source of revenue for healthcare organizations. Submitting incorrect claims time and again to these payers is a surefire way to get on their bad side, especially since many payers have their own unique requirements for claims. Why would a payer keep working with you if you consistently ignore their rules?
Claim scrubbers solve this problem. They lead to a substantial reduction in the number of erroneous claims you file, creating better relationships with your payers. Excellent claim-scrubbing practices can also help you make a case for yourself when connecting with new insurers to broaden your network. Thereafter, more patients are able to choose your practice.
Frequent claim denials don’t only affect payers. Patients often get annoyed when claims are denied. Think about it: After going to your doctor, wouldn’t you be irked if you got a bill for services you expected to be covered? A practice with patients who regularly experience this problem might not keep those patients for much longer.
Claim scrubbers again nip this issue in the bud. As they lower your claim denial rates, your patients are more likely to receive the coverage they expect for your services. When you meet the patient’s expectations, they’re far more likely to come back. Between patient retention and your expedited claims process, your practice is looking at more revenue more quickly.
Ready to use a claim scrubber in your practice’s billing operations? We’re here to help you find the right one. All the vendors in our medical billing best picks offer claim scrubbing. When you look at our best picks, you’ll see which vendor might be best for you based on your medical practice size, specialty, needs and other factors. Once you implement your medical billing system, consistently accurate claims – and the money that follows them – are nearly guaranteed.